The Mechanisms of Tinnitus: Research Progress and Treatment Implications

Patients will have more trouble coping on their own, as opposed to going to a tinnitus clinic. Any treatment from a concerned provider has been shown to offer a benefit to patients; investigators and clinicians are unclear as to whether that pertains to actually reducing the tinnitus or just supplying psychological support.

Experts agree that the very worst thing for patients is to tell them that there is no cure, there is nothing that can be done for them, and they will just have to learn to live with it. It is clear that a great majority of providers still give patients this negative feedback because by the time patients find the tinnitus experts, they often relate these unfortunate stories. Experts agree that even advising patients of the possibility of trying different modalities and combinations of therapies means something to them. (See Resources.) I cannot overemphasize the importance of avoiding negative counseling, said Pawel J. Jastreboff, PhD, ScD, MBA, a neuroscientist, professor, and Director of the Tinnitus and Hyperacusis Center at Emory University in Atlanta.

Certainly, patients who suffer from severe, disabling tinnitus should be referred to specialized clinics. Clinical information, combined with the basic science of brain and auditory function, is crucial in treating these challenging cases.

The concept that there will be a single drug or device that will cure all symptoms does not fit with what we know about the brain function, said Dr. Shulman. At this point it is important to focus on the positive findings for diagnosis, the positive findings for medical significance, and a rationale for therapy that has arisen from the overall body of investigative work.

Resources

For practitioners and patients:

• The Consumer Handbook on Tinnitus Richard S. Tyler, ed. Harris Communications, 2008.
• Save Your Hearing Now: The Revolutionary Program That Can Prevent and May Even Reverse Hearing Loss Michael D. Seidman, MD, and Marie Moneysmith. Wellness Central, 2007.

For practitioners:

• Tinnitus Diagnosis/Treatment Abraham Shulman, Jean Marie-Aran, Jeurgen Tonndorf, Harald Feldmann, Jack A. Vernon. Lea & Febiger, 1991; Singular Publishing Group, Inc. 1997; Martha Entenmann Tinnitus Research Center, Inc., 2004.
• Tinnitus: Treatment and Relief Jack A. Vernon. Allyn & Bacon, 1997.
• Tinnitus: Theory and Management James B. Snow. BC Decker Inc., 2004.
• Tinnitus: Pathophysiology and Treatment (volume 166) Aage R. Moller, Berthold Langguth (editors). Elsevier Science, 2007.

Additional References

• Bowyer SM, Seidman M, Elisevich K, et al. MEG Localization of the putative cortical generators of tinnitus. In: Cheyne D, Ross B, Stroink G, Weinberg H (eds). International Congress Series: New Frontiers in Biomagnetism: Proceedings of the 15th International Conference on Biomagnetism, Vancouver, BC, Canada, August 21-25, 2006:33-6.
• Bowyer SM, Seidman MD, Moran JE, et al. Coherence analysis of brain activity associated with tinnitus. In: Yokosawa K (ed). Biomagnetism-Transdisciplinary Research and Exploration. Proceedings of the 16th International Conference on Biomagnetism, Sapporo, Japan, August 25-29, 2008; in press.
• Daftary A, Shulman A, Strashun AM, et al. Benzodiazepine receptor distribution in severe disabling tinnitus. Int Tinnitus J 2004;10(1):17-23.
• Jastreboff PJ. Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neuroscience Research 1990;8:221-54.
• Seidman MD, De Ridder D, Elisevich K, et al. Direct electrical stimulation of Heschl’s gyrus for tinnitus treatment. Laryngoscope 2008;118(3):491-500.
• Shulman A. A final common pathway for tinnitus-medial temporal lobe system. Int Tinnitus J 1995;1:115-26.
• Shulman A, Avitable MJ, Goldstein B. Quantitative electroencephalography-Power analysis in subjective idiopathic tinnitus patients: a clinical paradigm shift in the understanding of tinnitus. An electrophysiologic correlate. Int Tinnitus J 2006;12(2): 121-32.
• Shulman A, Goldstein B. Tinnitus dysynchrony theory: a translational concept for diagnosis and treatment. Int Tinnitus J 2006;12(2): 115-20.

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